empty sella syndrome


Summary: A condition when the SELLA TURCICA is not filled with pituitary tissue. The pituitary gland is either compressed, atrophied, or removed. There are two types: (1) primary empty sella is due a defect in the sella diaphragm leading to arachnoid herniation into the sellar space; (2) secondary empty sella is associated with the removal or treatment of PITUITARY NEOPLASMS.

Top Publications

  1. Kubo S, Hasegawa H, Inui T, Tominaga S, Yoshimine T. Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome: technical note. Neurol Med Chir (Tokyo). 2005;45:428-32; discussion 432 pubmed
    ..of the sella floor in two patients who underwent chiasmapexy for visual disturbance associated with empty sella syndrome. A 36-year-old woman had been treated for prolactinoma for about 19 years with bromocriptine and then ..
  2. Schlosser R, Bolger W. Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg. 2003;128:32-8 pubmed
    ..b>Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a ..
  3. Weiss R. Empty sella following spontaneous resolution of a pituitary macroadenoma. Horm Res. 2003;60:49-52 pubmed
    ..A case of empty sella syndrome is presented. Static and dynamic testing was performed...
  4. Poggi M, Monti S, Lauri C, Pascucci C, Bisogni V, Toscano V. Primary empty sella and GH deficiency: prevalence and clinical implications. Ann Ist Super Sanita. 2012;48:91-6 pubmed
    ..This study confirms the necessity to screen the pituitary function in patients affected by PES and above all GH/IGF-I axis. Moreover the presence of GH deficiency could be clinically significant. ..
  5. Guinto G, del Valle R, Nishimura E, Mercado M, Nettel B, Salazar F. Primary empty sella syndrome: the role of visual system herniation. Surg Neurol. 2002;58:42-7; discussion 47-48 pubmed
    It has been traditionally accepted that ophthalmologic alterations in cases of primary empty sella syndrome are caused by the herniation of the visual system in the pituitary fossa, but this cannot be stated categorically...
  6. Wu Z, Su Z, Wu J, Zheng W, Zhuge Q, Zhong M. Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion. Pituitary. 2008;11:63-70 pubmed
    ..Great attention should be paid to CS residual tumors accompanying the empty sella, especially in cases with optic chiasmal herniation. ..
  7. Post K. Supplementary comment on "Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome--technical note--". Neurol Med Chir (Tokyo). 2005;45:491 pubmed
  8. García Centeno R, Suárez Llanos J, Fernández Fernández E, Andía Melero V, Sánchez P, Jara Albarrán A. Empty sella and primary autoimmune hypothyroidism. Clin Exp Med. 2010;10:129-34 pubmed publisher
    ..78% in our series. We suggest the possibility of a common pathogenesis for certain cases of ES and autoimmune thyroid disease, with the end point of ES in the pituitary, and atrophy in the thyroid gland. ..
  9. Tsukiyama A, Hattori Y, Tahara S, Ishisaka E, Morimoto D, Oyama K, et al. New Technique for Chiasmapexy Using Iliac Crest Bone Graft: 2 Cases of Visual Impairment Caused by Empty Sella Syndrome. World Neurosurg. 2017;107:1051.e19-1051.e25 pubmed publisher
    Chiasmapexy is used to treat empty sella syndrome, and various materials are used for the elevation of the optic chiasm...

More Information


  1. Hallstensen R, Svartberg J, Isaksen V, Bajic R, Løchen M, Hansen J. [Anemia and neutropenia in primary empty sella syndrome]. Tidsskr Nor Laegeforen. 2001;121:3391-4 pubmed
    ..Primary empty sella syndrome with isolated ACTH cortisol deficiency is a very rare cause of disturbed haematopoiesis.
  2. Tsutsumi Y, Kawamura T, Shiratori S, Mashiko S, Ibata M, Mori A, et al. Syndrome of inappropriate secretion of ADH after administration of intrathecal chemotherapy in acute promyelocytic leukemia with empty sella of pituitary gland. Ann Hematol. 2007;86:149-50 pubmed
  3. Skałba P, Jez W, Kabzińska M. [Anorexia nervosa in woman with Turner's syndrome]. Ginekol Pol. 2002;73:540-2 pubmed
    ..The inconsiderate start with HRT aggravated a course of a anorexia nervosa. The authors considered the plausible existence of relations between "empty sella" and the development of anorexia nervosa. ..
  4. Schlosser R, Bolger W. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association. Am J Rhinol. 2003;17:91-6 pubmed
    ..b>Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF ..
  5. Messina D, Bono F, Fera F, Lanza P, Giliberto C, Lavano A, et al. Empty sella and bilateral transverse sinus stenosis predict raised intracranial pressure in the absence of papilloedema: a preliminary study. J Neurol. 2006;253:674-6 pubmed
  6. Santhanam P, Saleem S, Saleem T. Diagnostic predicament of secondary adrenal insufficiency. Endocr Pract. 2010;16:686-91 pubmed publisher
    ..resection of a 4-cm pituitary tumor a few months previously, and the second patient had hyponatremia with empty sella syndrome. Both patients, however, had strong clinical evidence suggestive of secondary AI...
  7. Hillerer C, Wöller A, Mühlau M, Stimmer H, Zimmer C. [Neuroradiologic findings in Möbius syndrome]. Rofo. 2007;179:532-4 pubmed
  8. Taniguchi H, Muguruma K, Hiura Y, Inoue T, Kawa G, Kinoshita H, et al. [Acquired male hypogonadotropic hypogonadism (MHH) in a patient with empty sella: a case report]. Hinyokika Kiyo. 2008;54:791-3 pubmed
    ..Six months after hormone replacement therapy, semen analysis revealed azoospermia. Then we added r-hFSH to his treatment and expect his sperm to reappear. ..
  9. Komada H, Yamamoto M, Okubo S, Nagai K, Iida K, Nakamura T, et al. A case of hypothalamic panhypopituitarism with empty sella syndrome: case report and review of the literature. Endocr J. 2009;56:585-9 pubmed
    b>Empty sella syndrome is frequently accompanied with pituitary dysfunction. Most of the patients with empty sella syndrome demonstrate primary pituitary or stalk dysfunction and few cases show hypothalamic dysfunction...
  10. Kolyvanos Naumann U, Kaser L, Vetter W. [Secondary adrenal gland insufficiency]. Praxis (Bern 1994). 2003;92:843-5 pubmed
  11. Zhou P, Cheng S, Yang Z, Ma W, Dong W, Peng L, et al. [Repair and reconstruction of diaphragmatic defect during transcranial pituitary adenoma surgery]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2010;41:728-30 pubmed
    ..in the diaphragmatic reconstruction group, there were no leakage of cerebrospinal fluid(CSF), infections, empty sella syndrome (ESS), optic nerve damage, and any other severe complications was found...
  12. Ozveren M, Kaplan M, Topsakal C, Bilge T, Erol F, Celiker H, et al. Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure--case report. Neurol Med Chir (Tokyo). 2001;41:313-7 pubmed
  13. Mintz Hittner H, Semina E, Frishman L, Prager T, Murray J. VSX1 (RINX) mutation with craniofacial anomalies, empty sella, corneal endothelial changes, and abnormal retinal and auditory bipolar cells. Ophthalmology. 2004;111:828-36 pubmed
    ..This mutation also impacts on the maintenance of cone bipolar cells of the visual system and of bipolar cells of the auditory system. ..
  14. Pagán Sáez H, Milan R. Imaging technology in the diagnosis of sellar disease. P R Health Sci J. 1994;13:143-51 pubmed
    ..Several cases are presented where the diagnostic value of such procedures in patients with diseases affecting the pituitary gland is demonstrated. ..
  15. Jovanovic D, Kovacevic Z, Dragović T, Petrović M, Tadić J. [Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome]. Vojnosanit Pregl. 2009;66:166-8 pubmed
    ..Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS. ..
  16. Leães C, Ríos M, Passaglia J, Pereira Lima J, Oliveira M. Autoimmune polyglandular syndrome: an unusual presentation with empty sella, premature ovarian failure, and Hashimoto's thyroiditis associated with thyroid cancer. Gynecol Endocrinol. 2012;28:999-1001 pubmed publisher
    ..This case probably represents the first report on this tumor in a patient with polyglandular disorder. ..
  17. Cobb M, Crowson M, Mintz Cole R, Husain A, Berger M, Jang D, et al. Transnasal Transsphenoidal Elevation of Optic Chiasm in Secondary Empty Sella Syndrome Following Prolactinoma Treatment. World Neurosurg. 2018;112:250-253 pubmed publisher
    ..We review secondary empty sella syndrome and discuss surgical strategies for optic chiasmapexy.
  18. Mnif Feki M, Mnif F, Kamoun M, Charfi N, Rekik N, Naceur B, et al. Ectopic secretion of GHRH by a pancreatic neuroendocrine tumor associated with an empty sella. Ann Endocrinol (Paris). 2011;72:522-5 pubmed publisher
    ..Surgical resection of this pancreatic tumor was followed by significant amelioration of acromegalic signs and normalization of GHRH and GH levels. ..
  19. Taylor H, McLean S, Monheim K. Resolution of Cushing's disease followed by secondary adrenal insufficiency after anticoagulant-associated pituitary hemorrhage: report of a case and review of the literature. Endocr Pract. 2003;9:147-51 pubmed
  20. Ambrosi B, Faglia G. How much of our pituitary is really necessary?. J Endocrinol Invest. 2002;25:812 pubmed
  21. Incasa E, Tampieri M, Zangirolami A, Gamberini S, Di Chiara V, Boari B, et al. Hypothermia with loss of consciousness and hyponatraemia. Intern Emerg Med. 2007;2:113-5 pubmed
  22. Yoon P, Kim D, Jeon P, Lee S, Lee S, Kim S. Pituitary adenomas: early postoperative MR imaging after transsphenoidal resection. AJNR Am J Neuroradiol. 2001;22:1097-104 pubmed
    ..The purpose of this study was to establish the value of early postoperative MR imaging in differentiating residual tumor from postoperative surgical changes in the sella after transsphenoidal resection of pituitary adenomas...
  23. Visot A. [Neurosurgery and pituitary tumors: from preoperative tests to postoperative follow-up]. Presse Med. 2001;30:395-400 pubmed
    ..Secreting tumors are diagnosed by assessment of hypophyseal function, predictive of medical treatment efficacy and the value of hormone replacement therapy in case of surgery. ..
  24. Naswa N, Das C, Sharma P, Karunanithi S, Bal C, Kumar R. Ectopic pituitary adenoma with empty sella in the setting of MEN-1 syndrome: detection with 68Ga-DOTANOC PET/CT. Jpn J Radiol. 2012;30:783-6 pubmed publisher
    ..The application of 68Ga-DOTANOC PET/CT can be extended to multiple endocrine neoplasia type 1 patients, as is evident from this case study. ..
  25. Naing S, Frohman L. The empty sella. Pediatr Endocrinol Rev. 2007;4:335-42 pubmed
    ..The ES should not be considered as merely an incidental finding and clinicians should be aware of its varying presentations and ramifications. ..
  26. Melhus H, Astrom G, Ahlstrom H, Burman P, Karlsson A, Ljunghall S. Use of novel bone biopsy system to study molecular effects of growth hormone in human bone--a pilot study. IUBMB Life. 1999;48:175-8 pubmed
    ..Thus, this pilot study suggests that our novel bone biopsy system may be suitable for in vivo studies of the molecular effects of substances with essential functions in human bone. ..
  27. Paroder V, Miller T, Cohen M, Shanske A. Absent sella turcica: a case report and a review of the literature. Fetal Pediatr Pathol. 2013;32:375-83 pubmed publisher
  28. Zhai X, Zhang J, Liu G. [The characteristics and treatment of empty sella combined cerebrospinal fluid leakage of nasal]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012;26:1063-6 pubmed
    ..The patients with repeatedly recurrence can be considered to accepted the surgery of ventricle celiac bypass. It required long-term postoperative follow-up and review. ..
  29. Kuzman M, Jovanovic N, Vukelja D, Medved V, Hotujac L. Psychiatric symptoms in idiopathic intracranial hypertension. Psychiatry Clin Neurosci. 2008;62:367 pubmed publisher
  30. Agha A, Tomlinson J, Clark P, Holder G, Stewart P. The long-term predictive accuracy of the short synacthen (corticotropin) stimulation test for assessment of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab. 2006;91:43-7 pubmed
    ..The high-dose SST is safe for the purpose of excluding clinically significant secondary adrenal insufficiency and is indicated as the first line of investigation for this purpose. ..
  31. Brinkane A, Loucif T, Ounnadi Corbillé W, Damieri A, Levy R. [Empty sella turcica revealed by panhypopituitarism disclosed by severe hyponatremia]. Ann Endocrinol (Paris). 2003;64:281-3 pubmed
    ..We recall the mechanism of hyponatremia in this context and point at the importance of endocrine tests in patients with an empty sella turcica. ..
  32. Ertekin V, Selimoglu A, Orbak Z. Association of Bartter's syndrome and empty sella. J Pediatr Endocrinol Metab. 2003;16:1065-8 pubmed
    ..46). Urinary potassium and chloride levels were elevated. MRI of the brain was normal except for partially empty sella. We present the first pediatric patient with the association of Bartter's syndrome and empty sella. ..
  33. D Alessandris Q, Montano N, Bianchi F, Doglietto F, Fernandez E, Pallini R, et al. Persistence of primary empty sella syndrome despite obesity surgery: report of two unusual cases. Br J Neurosurg. 2012;26:875-6 pubmed publisher
    Primary empty sella syndrome (ESS) shares with idiopathic intracranial hypertension (IIH) high intracranial pressure (ICP) and association with obesity. Bariatric surgery is effective in IIH treatment; no data, however, exist about ESS...
  34. Wang E, Vandergrift W, Schlosser R. Spontaneous CSF Leaks. Otolaryngol Clin North Am. 2011;44:845-56, vii pubmed publisher
    ..obese women with radiographic evidence of skull base defects, associated meningoencephaloceles, and empty sella syndrome, a common sign of increased intracranial pressure...
  35. Gonzalez Tortosa J. [Primary empty sella: symptoms, physiopathology, diagnosis and treatement]. Neurocirugia (Astur). 2009;20:132-51 pubmed
    ..Bibliographical review on the primary empty sella: concept, symptomatology, diagnosis, physiopathology and management. ..
  36. Dange N, Redhu R, Kawale J, Mahore A. Primary amenorrhea due to empty sella: an underestimated entity. Turk Neurosurg. 2012;22:499-501 pubmed publisher
    ..We briefly review the radiological features, pathogenesis and outcome of this underestimated entity. ..
  37. Herrmann B, Mitchell A, Saller B, Stolke D, Forsting M, Frilling A, et al. [Transsphenoidal hypophysectomy of a patient with an ACTH-producing pituitary adenoma and an "empty sella" after pretreatment with etomidate]. Dtsch Med Wochenschr. 2001;126:232-4 pubmed
    ..Even if radiological procedures cannot show an adenoma of the pituitary, transsphenoidal resection should be considered. Etomidate can lower excessive cortisol levels in seriously ill patients. ..
  38. Durodoye O, Mendlovic D, Brenner R, Morrow J. Endocrine disturbances in empty sella syndrome: case reports and review of literature. Endocr Pract. 2005;11:120-4 pubmed
    To report 5 cases of empty sella syndrome (ESS) manifesting with various degrees of pituitary dysfunction...
  39. Hocking B, Andrews C. Empty sella and exposure to radio-frequency fields. J Trauma. 2003;54:1037-8 pubmed
  40. Yarman S, Minareci O. Value of petrosal sinus sampling: coexisting acromegaly, empty sella and meningioma. Neuroradiology. 2004;46:1027-30 pubmed
    ..We report all these rare entities in the same patient. We evaluated the role of inferior petrosal sinus sampling for lateralisation of an adenoma in this patient. ..
  41. Carli P, Graffin B, Landais C, Leyral G, Cremades S, Gisserot O, et al. [W. Busch and the enzymes of massive destruction...]. Rev Med Interne. 2005;26 Suppl 2:S270-1 pubmed
  42. Hori E, Akai T, Kurimoto M, Hirashima Y, Endo S. Growth hormone-secreting pituitary adenoma confined to the sphenoid sinus associated with a normal-sized empty sella. J Clin Neurosci. 2002;9:196-9 pubmed
    ..Primary empty sella existed originally, and the pituitary adenoma developed later. The adenoma extended into the sphenoid sinus because of the pulsatile intracranial cerebrospinal fluid pressure...
  43. Aldave A. VSX1 mutation and corneal dystrophies. Ophthalmology. 2005;112:170-1; author reply 171-2 pubmed
  44. Kubben P, Cornips E, Looij B, Beuls E. Transsphenoidal treatment of secondary empty sella syndrome using low field strength intraoperative MRI: case report. Minim Invasive Neurosurg. 2010;53:198-202 pubmed publisher
    The purpose of this study is to demonstrate the added value of intraoperative MRI in treating secondary empty sella syndrome. We describe the case of a 66-year-old woman who was diagnosed with a prolactinoma stage IIIb...
  45. Luutu I. Empty sella syndrome: incidental findings at computerised tomography. Afr Health Sci. 2001;1:26-7 pubmed
    ..Pre and post contrast axial and post contrast coronal computerised tomography scans through the sella turcica were done. An enlarged sella turcica filled with cerebrospinal fluid was demonstrated. ..
  46. Bala M, Brunnler T, Guralnik V, Scholmerich J, Schaffler A. [A 36-year old female patient presenting with hypoglycemic coma]. Internist (Berl). 2009;50:606-11 pubmed publisher
    ..Concomitantly, an empty sella syndrome was visible in MRI...
  47. Guinto Balanzar G, Mercado Atri M, Guinto Balanzar P, Nishimura Meguro E, Abdo Toro M, Aréchiga Ramos N, et al. [Sellar remodeling: a surgical option for primary empty sella syndrome]. Gac Med Mex. 2008;144:15-22 pubmed
    ..Sellar remodeling is a precise, simple, safe and inexpensive technique that significantly improves symptoms such as visual deficits and headache observed in primary empty sella syndrome.
  48. Jones M, Drut R, Valencia M, Mijalovsky A. Empty sella syndrome, panhypopituitarism, and diabetes insipidus. Fetal Pediatr Pathol. 2005;24:191-204 pubmed
    ..We discuss the possible pathogenesis of these findings as well as lines of evidence available in the literature. ..
  49. Laube H, Erkal Z, Bilgin Y. [Turner syndrome, autoimmune thyroiditis and partial "empty sella turcica."--an unusual case in a progressed aging unrecognized diagnostic combination]. Dtsch Med Wochenschr. 2002;127:500-1 pubmed
  50. Milosević M, Stojanovic M, Nesović M. [Primary hypothyroidism associated with empty sella turcica and hypopituitarism]. Med Pregl. 2005;58:410-3 pubmed
    b>Empty sella syndrome is a rather frequent neuroradiological finding in the general population and can be associated with hypopituitarism. Examinations reveal low pituitary hormone levels and lack of response to stimuli...
  51. Catrinoiu D, Mihai C, Tuta L, Stoicescu R, Simpetru A. Rare case of Alstrom syndrome with empty sella and interfamilial presence of Bardet-Biedl phenotype. J Med Life. 2009;2:98-103 pubmed
    ..Genetic studies in such patients may provide new data regarding the consequences of defective cilia and a possible identification of new gene mutations. ..
  52. Ho K. Coexistence of primary empty sella and silent corticotrophic adenoma. Mod Pathol. 1996;9:521-5 pubmed
    ..The en bloc preparation of the sella turcica demonstrates the anatomical relationship of the empty sella and the flattened pituitary gland and the adenoma. The immunostain shows the presence of all five cell types of the adenohypophysis...
  53. Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P. Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci. 2008;1:42-50 pubmed
    ..Hyponatremia can be a life-threatening presenting symptom. Symptoms considered apparently aspecific in the elderly should be investigated in order to possibly diagnose an important treatable disorder as HYPO. ..